How Addiction Affects The Transgender Community

Medically Reviewed by Johnelle Smith, M.D. on September 21, 2022

Transgender people may be at a higher risk of substance abuse and dependence than cisgender people. Yet there are resources available to help people in the transgender community get the behavioral health treatment they need.

Addiction In The Transgender Community

In recent years, the transgender community has made great strides in the movement for equality, particularly on issues such as marriage and workplace discrimination.

Despite these gains, transgender people are still impeded by stigmatization, intolerance, and high rates of mental illness and substance abuse.

It is estimated that between 20 to 30 percent of transgender people abuse substances, which is two to three times higher than that of cisgender people.

Luckily, there are resources and treatment options for substance use available for the transgender community throughout the United States.

What It Means To Be Transgender

When we’re born, most people who were labeled male or female grow up to choose the gender that matches the sex they were assigned at birth. Transgender people are individuals whose gender identity differs from the gender they were assigned at birth.

Being transgender means different things depending on the person, and there’s no correct way to be transgender. People who are transgender occupy a spectrum of experiences in both the way they look and feel about themselves.

A transgender person can be gay, lesbian, straight, or bisexual, just like someone who is cisgender. Gender identity does not necessarily predict who someone may be sexually or romantically attracted to.

The best way to understand what being transgender means is to talk with transgender people and listen to their lived experiences.

Rates Of Alcohol And Drug Addiction In The Transgender Community

According to the Centers for Disease Control and Prevention (CDC), transgender people represent less than one percent of the population.

While there is little data on the rate of substance abuse in transgender people, studies point to a substantially higher rate than cisgender people in the same age groups.

The following information is based on studies conducted through the Substance Abuse and Mental Health Services Administration (SAMHSA).

Rates Of Alcohol Use Disorder

Twenty-five percent of transgender people report drinking alcohol on a monthly basis, compared to five to ten percent of cisgender people.

Rates Of Prescription Drug Abuse

Transgender people are two to three times more likely to misuse prescription pain medications, such as opioids, than cisgender people.

Rates Of Illicit Drug Abuse

Illicit drug use, such as cocaine and methamphetamine abuse among transgender individuals is approximately 2.5 times higher than the general population.

Risk Factors For Addiction Among Transgender People

A transgender person is not inherently more inclined to abuse drugs and alcohol. However, there are a number of factors that may contribute to the prevalence of addiction in this community.

Mental Health Disorders

According to surveys conducted by LGBTQ+ rights organizations such as the Human Rights Campaign, the number of transgender people with mental health issues is higher than other population groups.

Mental health disorders such as depression, bipolar disorder, and anxiety disorder can contribute to substance abuse. Transgender people may use drugs or alcohol to help them cope with the symptoms of mental illness.

Gender Dysphoria

Gender dysphoria describes the stress and sense of unease that a person may feel because of a disparity between the gender with which they currently identify and the sex they were assigned at birth.

Symptoms of gender dysphoria may include a desire to be treated as the opposite gender or a strong need to no longer have the primary sex organs of their assigned gender at birth.

Some transgender people may develop severe depression due to gender dysphoria and may turn to substance abuse as a result.

Post-Traumatic Stress Disorder (PTSD)

PTSD is a condition that arises after a traumatic event such as witnessing or experiencing violence or sexual assault.

People with PTSD will oftentimes experience flashbacks, nightmares, changes in mood or thinking, and a heightened state of anxiety.

PTSD and addiction triggers among transgender people can intertwine and intensify the effects of both disorders.

Family History Of Substance Abuse

The Nation Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that a family history of addiction is one of the most significant risk factors for developing a substance use disorder.

If a person’s family member, such as a parent or sibling, has developed an addiction to drugs or alcohol, the chances are higher that they will develop substance abuse issues of their own.

Treatment Options For Transgender People With Substance Use Disorders

There are several evidence-based addiction treatment methods that are effective for transgender people with substance use disorder.

Additionally, some treatment programs may include individual or group counseling for issues such as gender dysphoria, sexual identity, and more to target the underlying causes of addiction.

Medication-Assisted Treatment (MAT)

MAT refers to the use of medications, in combination with behavioral therapies to help reestablish normal brain function, reduce substance cravings and prevent relapse.

Common medications prescribed during MAT include methadone, naltrexone, and buprenorphine for opioid use disorder.

Cognitive Behavioral Therapy (CBT)

One of the most common substance abuse treatments for transgender people is cognitive behavioral therapy (CBT).

This type of therapy involves attempting to change thinking patterns in clients with substance use disorders and other mental health issues.

Residential Treatment

Transgender people with severe drug or alcohol addiction may benefit from short-term or long-term inpatient treatment at a rehab facility.

Residential treatment centers offer highly monitored, intensive, live-in programs where clients are supervised by trained staff.

Outpatient Treatment

Outpatient treatment refers to a variety of services such as individual therapy, group therapy, or support groups that a person may attend on a weekly basis. These programs don’t require the client to live at the facility.

Aftercare Services

After a transgender person finishes the early phase of their residential or outpatient treatment, aftercare services are often provided to help people in addiction recovery adapt to everyday life.

Aftercare plans may include additional resources, enrollment in activities, or interventions designed to assist a person in coping with stress, cravings, and potential triggers.

Barriers To Transgender Substance Abuse Treatment

Transgender people seeking treatment for substance abuse may be presented with an array of barriers to dissuade them from getting the help they need.

Some of the problems that may arise include:

  • inadequate access to affordable healthcare services
  • fear of physical or verbal abuse from other clients or staff
  • requirements for wearing only clothing or cosmetics related to their gender assigned at birth
  • housing that requires a transgender person to live with members of the opposite gender identity
  • misgendering, or using the person’s original birth name or pronoun instead of their current chosen name

Issues such as these may be rare in occurrence but can prove to be extremely damaging and offensive to transgender people during addiction recovery.

Is Hormone Replacement Therapy Offered In Addiction Treatment?

Hormone replacement therapy (HRT) allows a person to change their physical appearance to match their gender identity by manipulating the estrogen and testosterone levels in their body.

Depending on the drug rehab center, transgender people may not have continued access to the pills, patches, or shots they use for gender-affirming hormone therapy when they enter a treatment program.

Some facilities specialize in issues related to LGBTQIA+ people, including the administration of HRT. To avoid a lapse in HRT, transgender clients can contact the rehab center directly and ask about their policy on hormone therapy.

Tips For Transgender Loved Ones With Behavioral Health Issues

If you or a transgender loved one are seeking behavioral health treatment, there are a number of tips that may ease the process of getting help and achieving long-term sobriety.

1. Find A Trans-Affirming Therapist

Be sure that the treatment program you attend offers gender affirmative therapy. This type of therapy requires therapists to get continued education and training in gender diversity.

2. Create A Robust Support System

Family support and connection are one of the most important factors in the lives of transgender people, particularly individuals with mental health or substance abuse issues.

There are also support groups available at LGBTQ community and treatment centers across the United States where people can find a supportive community.

3. Obtain Adequate Health Insurance

Obtaining health care insurance will greatly increase the chances of finding an appropriate treatment program for transgender people.

If private insurance is unaffordable, each state in the nation offers a Medicaid program so people with lesser financial means can get the healthcare they need.

4. Learn About Policies That Affect The LGBTQ Community

Depending on where you live, there may be laws or policies in place that discriminate against transgender people.

It’s important to learn about the challenges that transgender people face as well as the goals of transgender advocates.

5. Be Aware Of Gendered Language

Consider changing your language to avoid making assumptions about people’s pronouns and gender.

Being misgendered can feel extremely invalidating and frustrating. This can be especially difficult for people who are already facing problems with their mental health, and need support and affirmation.

Resources For People Who Are Transgender And Need Addiction Treatment

Finding treatment for substance use can be stressful, but help is available in the form of rehab programs, government resources, and nonprofit organizations dedicated to supporting the transgender community.

Drug And Alcohol Treatment Resources For Transgender People

  • CenterLink LGBT Community Center Member Directory — This tool can connect transgender people with lgbtq-welcoming community centers. While you may not be able to find addiction treatment directly at these centers, these facilities may be able to refer you to a healthcare facility that provides the behavioral health care you need.
  • Health Resources and Services Administration’s Find A Health Center Tool — The U.S. Department of Health and Human Services has been providing training for and guidance on how to be more welcoming to LGBTQ individuals. By searching for a community health center, you may be able to find a referral to a trans-welcoming health center.
  • Human Rights Campaign’s Healthcare Facilities Search Tool — This tool offers a database of more than 2200 healthcare facilities and hospitals that were vetted by the HRC through a national survey to provide inclusive, informed treatment services.

Support For People Who Are Transitioning

  • Gay and Lesbian Alliance Against Defamation (GLAAD) — GLAAD is an organization dedicated to accelerating acceptance for LGBTQ people in media and provoking dialogue that leads to cultural change.
  • Human Rights Campaign — The Human Rights Campaign is the largest LGBTQIA+ advocacy organization in the United States. Here, people can find resources such as sexual health information, employment opportunities, scholarship databases, and more.
  • The Trans Needle Exchange — This organization provides access to hormone replacement therapy through a non-profit, mail-based, safe needle exchange program.

Resources For Transgender Youth

  • It Gets Better Project — The It Gets Better Project empowers LGBTQIA+ youth through inspiring media programming, educational resources, and access to several community-based service providers.
  • NIDA for Teens — NIDA for Teens offers a wealth of information about the effects of drugs and alcohol for adolescents, their parents, and educators.
  • The Trevor Project — The Trevor Project provides information and support to LGBTQ young people. Free counseling is available here for teens thinking about self harm or wanting to discuss their gender identity and sexual orientation.

Legal Resources For Transgender People

Resources For Transgender Veterans

Resources For Allies

This page does not provide medical advice. See more

Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.

These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.

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Medically Reviewed by
Johnelle Smith, M.D. on September 21, 2022

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